RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-01439
BRANCH OF SERVICE:  ARMY 	SEPARATION DATE:  20060730

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E6, Cable System Installer/Maintainer, medically separated for “mechanical low back pain” with a disability rating of 10%.

CI CONTENTION:  No specific contention made.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (MEB), but determined by the PEB to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions; that role and authority is granted by Congress to the Department of Veterans Affairs, which operates under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.   

RATING COMPARISON:  

SERVICE PEB - 20060523	VARD - 20060907	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Mechanical Low Back Pain	5299-5237	10%	Strain, Lumbar Spine	5237	10%	20060711	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Mechanical Low Back Pain.  According to the service treatment record and MEB narrative summary (NARSUM), the CI’s back condition began in 2004 without any specific injury or trauma and was unresponsive to non-operative management.  An MRI on 25 October 2004 was normal as were  X-rays on 20 September 2005.  

During the 24 February 2006 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported chronic back pain.  Physical examination showed left paraspinal tenderness and decreased range of motion (ROM) limited by pain, but no measurements were provided.  Motor, reflexes and sensation were normal, as was gait.  At the MEB physical therapy (PT) evaluation the same day, thoracolumbar ROM measurements were flexion of 55 degrees (normal 90) and combined ROM of 155 degrees (normal 240) after repetition, with painful motion.  

The 18 April 2006 MEB NARSUM examination, 3 months prior to separation, noted CI complaints of frequent pain, intermittent muscle spasms, and cramping which were aggravated by sitting, standing for prolonged periods, running and jumping.  Conservation treatment had not improved symptoms.  Physical examination showed normal motor, strength and sensation.  

At the 11 July 2006 VA Compensation and Pension (C&P) evaluation, less than 1 month before separation, the CI reported back pain with cramping 3-4 times per week that lasted for a couple hours.  Physical examination showed a normal gait and posture.  Measured ROM was flexion of 90 degrees and combined ROM of 240 degrees, with pain in all planes and tenderness noted.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the back condition 10%, analogously coded 5299-5237 (lumbar spine strain), citing ROM limited by pain and tenderness to palpation.  The VA also rated the back condition 10%, coded 5237, based on the C&P evaluation, citing painful motion.  Members noted that the limitation of thoracolumbar motion recorded at the MEB PT examination met the threshold for a 20% rating with flexion of 55 degrees.  However, the C&P evaluation, 3 weeks before separation, recorded flexion of 90 degrees and a combined ROM of 240 with tenderness and painful motion, and was more consistent with outpatient notes and reflective of anticipated severity based on clinical pathology.  Therefore, the panel placed greater probative value on the VA examination and agreed a 10% rating was justified for painful motion with tenderness to palpitation.  There was no muscle spasm or guarding severe enough to result in an abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no documentation of intervertebral disc syndrome with incapacitating episodes which would provide for a higher rating under that formula.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the  back condition.  

BOARD FINDINGS:  In the matter of the mechanical low back pain condition and IAW VASRD §4.71a, the panel recommends no change in the PEB adjudication.  There are no other conditions within the panel’s scope of review for consideration.  Therefore, the panel recommends no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20170226, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record  

AR20180004883, XXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					      
Enclosure